Last Sunday in the NYT Natasha Singer published an article titled ‘Better Health, With a Little Help from Our Friends’ http://tiny.cc/08b72 She presented compelling information that social networks can aid in influencing and changing healthcare behavior for both good and bad. As I read and reread that article I was struck by the implications of the research she presented for SM and how it may be applied locally to improve outcomes. I want to look at some of the data supporting her writing and what it may mean for SM in HC.

The work Singer presented was focused on live networks of people and communities and their effect on HC behaviors. A NEJM of article by Fowler and Christakis titled ‘The Spread of Obesity in a Large Social Network over 32 Years’ http://tiny.cc/j5b02 “the chance of becoming obese was influenced not only by the weight gain of friends but also by friends of friends who gained weight.” In this article Fowler and Christakis said, “People are connected, and so their health is connected.” This is the key to improving outcomes in HC. Can we create hubs of influence where patients congregate to find solutions to their common HC problems?

During chats and posts of HCSM the primary premise is SM is an answer to HC that can drive change. But it is not simply establishing networks and SM. It is the way the network is structured, who is in it, how it functions, and what it does to reinforce change. I have a strong bias toward adult learning in that adults want to find solutions to problems they are having and that learning has two fundamental aspects for it to be successful. It must have affect and must be social. I have posted on this. In my mind the Singer article demonstrated tools that can be applied to SM in HC in order to increase the effectiveness of learning, which will improve outcomes.

Singer presented recent work by Damon Centola who examined the structure of social networks and how fast people adopt and stick to health habits. His work is summed up in this quote from Singers article “It makes a big difference how you connect people than who is there in influencing desirable behaviors. His recent article in Science ‘The Spread of Behavior in an Online Social Network Experiment’ http://tiny.cc/hqqg4 examined this issue. It is a very technical read and built on his earlier work “Complex Contagion and the Weakness of Long Ties” AJS 113 No. 3 November 2007 702-34.

Singer examines ties within networks and how they influence participants. Strong ties are close friends and family who are highly important to us, family, friends, our PCP who we are seeing to manage our health. Weak ties (long ties) are those we are connected with less frequently and do not highly influence us. Lady Gaga’s 6 million friends on FB is an example of weak (long) ties. Strong ties (wide bridges) influence more powerfully. Weak ties offer the ability to rapidly spread information.

I want to quote from Centola’s conclusion, “We found that long ties do not always facilitate the spread of complex contagions and can even preclude diffusion entirely if nodes have too few common neighbors to provide multiple sources of confirmation or reinforcement. While networks with long, narrow bridges are useful for spreading information about an innovation or social movement, too much randomness can be inefficient for spreading the social reinforcement necessary to act on that information, especially as thresholds increase or connectedness declines.”

How does this work apply to HC outcomes and SM? What are the practical applications relevant to our #HCSM chats and our collective interest?

First there are two assumptions I want to make:
•What is presented will be within HIPAA guidelines.
•The work to do this does not fall on the physicians shoulders but is done via an outsourced model that is at worst revenue neutral but hopefully positive.

HC is Local: There are 900 million physician office visits each year compared to 35 million hospital admissions/visits. HC is in the office not in the hospital. Hospitals treat patients, physicians manage patients. It stands to reason the key locus for patients and outcomes is the office.

When adults seek solutions to HC problems they go to Bing, Google, WebMD, national organizations, their friends, etc. I would offer a different model, MyMD.com, a PCP web site/portal built to focus the physicians’ patients to find information and links. It is a place for patients to go that is trusted. It’s local with high HC value. (Who is more trusted than your MD?) The physician and the web site/portal become a hub for patients in search of information. These are not huge sites like WebMD but sites with links and basic trusted information and articles built around patient/practice demographics. MyMD is local, patients are local, it’s a HC neighborhood that can reinforce knowledge and outcomes.

Networks: Use the MyMD web site /portal as a place where patients with similar diseases (HTN, diabetes, obesity, etc.) can build small communities around their PCP. Offer Tweet ups for patients with similar issues. Allow them to meet and chat based on the articles and thoughts of their PCP. Again, to be clear, this is not a place to treat and Rx. It is a place to learn and share with clear rules of engagement. Knowledge coalesces around their physician.

Maximize diffusion: Using the work cited above create wide and long ties. Invite patients from national organizations to participate in order to diffuse new knowledge quickly. Include trusted patients and experts who would offer wide ties of influence. Create discussions around problems patients want to solve and ask them to share experiences and knowledge in order to create reflection.

Larger portals:Carmen presented a review and look at the Mayo Clinic patient portal ‘Patient Portals: Socially Wired to Future Health Care. Tie patients back to their hospital based patient portal if it exists.

Measure and Monitor: Examine the actions and behavior of patients participating in the local PCP knowledge portals. Learn what problems patients within the practice are seeking solutions in order to offer ideas and knowledge and most of all allow them to share experiences and knowledge in order to reflect and include new behaviors in their HC lives. And most of all look to measure outcomes and identify change.

Hospital Benefits: Hospitals have a vested interest in improving outcomes at the referring physician’s office. In the not to distant future as HC reform takes hold hospitals will be measured on outcomes. X number of patients enter the hospital each year. As an administrator I am hoping to get them in, treat, discharge quickly and have no readmission. Therefore, I want patients admitted in a better state of health. I want diabetic ulcers not gangrene. The latter may be more expensive but effect’s my outcomes. MyMD web site/portal is a way for me to help referring physicians better serve hospital goals.

Revenue: Perhaps a local bike shop would want to place an ad on the site. Maybe Trek would want to been seen here. What should not be done is have pharma or others with a commercial interest in HC products participate. This cannot work without some revenue.

These are just a few ideas on taking the work presented above and applying it to real world practice to improve HC outcomes. MyMD site/portal does not have to be complex. It needs to be a place, a waiting room with information and like-minded friends both old and new who share knowledge and help each other to learn and make the changes they want to make within their ‘HC neighborhood’. Most of those 900 million patient visits last year were for check ups and routine healthcare and those visits are not driven by problems that need solutions. Therefore the audience using this MyMD web/portal is smaller and wants and needs to make changes. They may or may not be motivated but from the data it seems we can use networks and social media to drive change. But what we cannot do and what frosts my ass is this assumption that the pretty little toy called SM will in and of itself drive HC change or improve outcomes or make coffee and cure acne. SM is a tactic; it needs a strategy and principles in order to succeed. There appear to be hundreds of research papers examining networks and how they function. Apply them to SM.

I am a GED in a roomful of PhDs who dares to quote Centola, Fowler, and Christakis. I worry my logic may be ill and I’ve misunderstood their work but I think I’ve got the idea right. We need to use science and knowledge in SM to drive change. My hope is that comments, questions, and interest will spur discussion. Bless Steve Jobs’ rented liver. iTunes and now iPing are interesting models of knowledge and SM. Maybe just maybe we’ll interest someone, some HC provider, etc. to build this as a model and test it. I know I’m ready.